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[A successful case report of coronary artery bypass grafting under ventricular fibrillation with circulatory arrest]
Y Nakayama1, Y Okazaki, Y Katayama
1Department of Cardiovascular Surgery, Koga Hospital, Fukuoka, Japan.
Insights
This study details a successful coronary artery bypass grafting surgery on a patient with severe aortic calcification. The technique utilized circulatory arrest and intraoperative ultrasonography, avoiding aortic cross-clamping for a safe procedure.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Severely calcified ascending aorta poses significant challenges during coronary artery bypass grafting (CABG).
- Traditional cardiopulmonary bypass with aortic cross-clamping carries increased risks in such patients.
- Minimally invasive techniques are sought to improve outcomes for complex CABG cases.
Observation:
- A 78-year-old female patient presented with severe ascending aorta calcification requiring CABG.
- The surgical team employed ventricular fibrillation, hypothermia, and circulatory arrest.
- Intraoperative ultrasonography identified a suitable, non-calcified segment of the aorta for proximal anastomosis.
Findings:
- Coronary artery bypass grafting was successfully completed without aortic cross-clamping.
- Bilateral internal thoracic arteries and a saphenous vein graft were utilized.
- Postoperative coronary angiogram confirmed excellent graft patency.
- The patient experienced an uneventful recovery with no neurological complications.
Implications:
- Circulatory arrest combined with intraoperative ultrasonography offers a viable solution for CABG in patients with severely calcified aortas.
- This approach may reduce the risk of stroke and other complications associated with aortic manipulation.
- The technique demonstrates potential for improved safety and outcomes in high-risk CABG patients.
Abstract:
Coronary artery bypass grafting in a 78-year-old female with severely calcified ascending aorta was performed successfully. Bilateral internal thoracic arteries and saphenous vein were anastomosed under ventricular fibrillation and hypothermia without aortic cross-clamping. Proxymal anastomosis of saphenous vein graft was performed directly under circulatory arrest in a normal part of ascending aorta which was confirmed by intraoperative ultrasonography. Weaning from ECC was easy and no neurological complication was observed after operation. Bypass grafts were patent on postoperative coronary angiogram and postoperative course was uneventful. We think the technique of circulatory arrest and intraoperative ultrasonography were useful in a patient with severely calcified ascending aorta.